Number or percent of service delivery points which offer a range of appropriate contraceptive options for postpartum women

Definition:

The number or percent of maternal and child health (MCH) service delivery points (SDPs) which offer a range of appropriate contraceptive method options for postpartum women, assessed during a specified time period (e.g., one year). In order to be counted for the indicator, the SDP should be providing contraceptive services onsite rather than as client referrals

The recommended contraceptive options for postpartum women include the lactational amenorrhea method (LAM) for the first six months and methods that do not interfere with breastfeeding and are safe to use any time after birth including: condoms; IUD (non-hormonal); diaphragm; vasectomy; and tubal ligation. The full range of postpartum contraceptive options are presented below.

SDPs include all public, private, non-governmental and community-based health facilities and outlets in which MCH services are offered, including antenatal care, labor and delivery, postpartum and/or infant and child care.

This indicator is calculated as:

(Number of SDPs that offer a range of appropriate postpartum contraceptive methods / Total number of SDPs in a designated area) x 100

This indicator is closely related to the recommended USAID/CORE Group’s postpartum care indicator for Health facilities providing a range of contraceptive methods (USAID/CORE Group, 2004). For further information on assessing availability of contraceptive methods and services, see the sections in this database on Commodities, Securities and Logistics; Service Delivery; and Health Systems Strengthening.

Data Requirement(s):

Data on which contraceptives are available at SDPs, subset by those types appropriate for postpartum women. Ideally method availability should include commodities, as well as service provision and counseling for the methods, such as on the use of LAM. A comprehensive facility survey instrument called the Service Provision Assessment (SPA) has been developed by USAID and Macro International Inc. to be used with nationally representative samples of health facilities to provide information on the characteristics of health services, including availability of FP methods and postpartum care (MEASURE DHS, 2011). The data can be disaggregated by the type of facility or program (public, private, non-governmental, community-based, etc.), by the specific types of methods available, and by other relevant factors such as districts, urban/rural location, and target populations.

Data Source(s):

Facility registers on services provided;inventory records; specialized surveys, such as SPA; and information management systems. In countries where available, DELIVER Project data can be used to assess supplies for a range of modern contraceptive methods that will include methods appropriate for postpartum women (DELIVER, 2006; DELIVER, 2011).

Purpose:

This indicator measures the availability of contraceptive methods appropriate for women during the postpartum period and can be used to compare and track trends in the integration of postpartum FP with MCH services. Optimally, MCH programs and services can provide a range of methods to meet the needs of postpartum women for limiting and spacing pregnancies. FP use during the first year postpartum has the potential to significantly reduce the number of unplanned pregnancies leading to fewer closely spaced pregnancy intervals, and decreases in maternal and child morbidity and mortality. The integration of the range of contraceptive methods for postpartum women with MCH programs and services provides opportunities to streamline and improve care at the most favorable and critical times for maximizing women’s reproductive health and the health of their children. Multiple contacts with MCH services during the antenatal and the postpartum periods have been shown to increase women’s use of FP methods by six months postpartum and decrease unmet need for FP (USAID/ACCESS-FP/ Frontiers, 2008). The benefits associated with combining FP and MCH services are directly related to achieving Millennium Development Goals #4 reduce child mortality and #5 improve maternal health.

Issue(s):

This indicator measures availability of postpartum contraceptive methods and services, but the overall access to, distribution of, and quality of services can best be measured using a range of indicators that provide data on method procurement, storage, affordability, travel time to facilities, staffing, delivery of method services and follow-up, and client utilization and satisfaction (WHO, 2010).

It is important to note the distinction between whether a site offersa given contraceptive option (in other words that the method is defined to be part of the site’s postpartum method mix) and whether a site has the resources it needs to actually provide the FP service at an adequate level of quality. A relatively large proportion of interviewees or facility registers may report that several postpartum FP options are offered, however a significant proportion of these sites may not be currently offering the FP services because they do not have a provider who has been trained in the provision of that service in the past three years or the site may not have all the appropriate supplies and instruments.

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